Mechanomyography as a Non-Invasive Technique for Diaphragm and Chest Wall Muscle Assessment in COPD Patients

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
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Introduction
Chronic obstructive pulmonary disease (COPD) is a lung obstructive disease that is
branded by long-standing breathing difficulties and poor respiratory functions. The patient
experiences difficulties in breathing, a productive cough and shortness of breath (Brij, Chatterji
& Marquette, 2016 p245). The disease is a progressive condition hence the symptoms worsen
with time. Therefore, the daily activities become difficult such as dressing, walking, and other
simple tasks. There are various causes of COPD that include genetics, tobacco smoking, and
pollution. However, the most common cause of this disease is the smoking of tobacco while the
other factors play a smaller role. Air pollution that causes this condition is due to poorly
ventilated heating and also cooking fires that have not undergone complete combustion (Brij,
Chatterji & Marquette, 2016 p250). The long-term exposure to these agents leads to the
development of an inflammatory response in the respiratory systems, especially in the lungs. The
airways become smaller and narrower while the lung tissues are destroyed. Diagnosis of COPD
is based on the determination of inefficient air flow measured by tests on lung functions.
Prevention is done by improving the outdoor and indoor air quality. Treatment is through
stopping smoking, lung transplant and rehabilitating the respiratory system. COPD is treated
using bronchodilators, steroids and oxygen therapy and there is also a vaccination that is given to
prevent this condition (Amal et al. 2017 p250).
Literature Review
In this article I will do a literature review for the patients that have COPD and the
relationship that exists between diaphragm and wall mechanomyography (MMG), EMG muscle
signals in patients that have COPD while comparing it with the lung functions of healthy
subjects and the identification of the muscles which will be affected by COPD during quiet

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breathing due to the severity of COPD (Chlif et al. 2016 p228). Mechanomyography has been
applied for detecting signals in the respiratory system to quantify the diaphragm muscle and the
coastal wall muscles functions and performance. This mechanism has been favored since it is
efficient and its intrinsic mechanical nature and the ability to assess muscle activity and function
non-invasively and at the same time preserving the muscular neuropathologic information. MMG
is used together with electromyogram (EMG) to determine diaphragmatic muscle efficiency and
respiratory power in patients with COPD (Sarlabous et al. 2017 p434).
Respiratory muscle dysfunction is the major problem that is experienced by patients with
chronic obstreperous respiratory conditions and has been connected to the pulmonic
hyperinflation (Sarlabous et al. 2017 p434). This condition is associated with diaphragm
shortening and other harmful changes that occur in the muscle force-size relationship hence
leading to reduced muscle ability to generate pressure hence they have a mechanical
disadvantage. Inspiratory muscle mechanical efficiency and strength may be reduced in patients
with this condition (Sarlabous et al. 2017 p434). However, at isovolume, the contracting force of
the diaphragmatic muscle in patients with COPD may be conserved or even enhanced in some
few instances. By the use of the MMG, the ratio between the electrical diaphragm activity and
the trans-diaphragmatic pressure can be used to measure the efficiency of the respirational
muscles which include the diaphragm muscle and the intercostal muscles which aid in respiration
during the periods of quiet breathing.
The gold standards in the assessment of diaphragm contractility in patients with
respirational illnesses such as chronic obstructive pulmonic disease involve the invasive
measures of the trans-diaphragmatic pressure. The surface MMG is a non-invasive method used
to assesses muscle fiber vibration during contraction. There is a great correlation between